Although osteoporosis affects all bones in the body, breaks are most common in the hips, wrists
and spine. More than 40 million people already have osteoporosis or are at risk because of low bone
mass. Osteoporosis can strike at any age, although the risk of developing the disease increases
with age. In the future, more people will be at risk of developing osteoporosis because people are
living longer and the number of elderly people in the population is increasing.

Signs

• Sloping shoulders

• Curve in the back

• Height loss

• Back pain

• Hunched posture

• Protruding abdomen

Risk factors

• Being female

• Getting older

• Menopause

• Not getting enough exercise

• Having a small, thin body (less than 127 pounds)

• Having a family history of osteoporosis

• Smoking

• Drinking more than one drink a day for women

• A diet low in dairy products or other sources of calcium and vitamin D

Sources: National Institutes of Health, U.S. Department of Health and Human Services

As she stood in the shower, Joyce Morison propped one leg on the side of the tub and balanced on
the other — the classic leg-shaving stance familiar to women everywhere.

But then Morison heard a sound that was not part of the routine.

“A pop, almost as if you snapped your fingers,” she said. “All at once, I was sitting down.”

Morison’s left femur had snapped. The injury she suffered in 2008 was excruciating and also
mysterious: Morison did not have osteoporosis and in fact had been taking Fosamax, a
bone-strengthening bisphosphonate, for 12 years.

“I was told that I was a good candidate for osteoporosis,” said Morison, now 65.

A doctor had prescribed medication because bone-mineral-density tests put the Bexley resident in
the
osteopenia range, a term for low bone density.

But osteopenia isn’t really a diagnosis, and some doctors say too many people are being treated
for something that is often wrongly viewed as a precursor to full-blown osteoporosis.

Some researchers also suspect that long-term use of the popular drug Fosamax could actually lead
to more fractures by rendering bones brittle. The link has not been proved in clinical trials, but
reports of femur fractures such as Morison’s are being tracked.

Dr. Seth Kantor, an OhioHealth rheumatologist, said diagnostic problems arise when clinicians
and patients focus too much on the result — known as the T-score — read by a scanning machine that
measures bone-mineral density.

World Health Organization guidelines say T-scores from minus-1.0 to minus-2.5 mean a patient has
low bone density; a T-score of minus-2.5 or below signals osteoporosis.

But that’s only part of the picture. Determining a patient’s actual risk of fracture, and thus
the potential need for treatment, depends on a variety of factors such as age, weight, race, family
history of osteoporosis, and overall health and fitness.

“If you ask, ‘At what T-score should I start treatment?’ the answer is: ‘There is no answer,’ ”
said Kantor, who sees patients at the Grant Arthritis and Osteoporosis Center. “What has happened
is that a lot of doctors and patients focus on the bone mass and not bone quality.”

Dr. Velimir Matkovic, director of the Osteoporosis Prevention and Treatment Center at Wexner
Medical Center at Ohio State University, has studied bone-mineral density for more than 40 years.
Like Kantor, he laments the overuse of the word
osteopenia.

“Since the mass screening with DXA (dual-energy X-ray absorptiometry) machines has taken place,
this term has been used as an intermediary level of mineralization,” Matkovic said. “It’s a reading
on a machine.”

He said he regularly sees women, especially younger ones, who are taking medicines they probably
don’t need.

“In my clinic, I eliminated more of those prescriptions than I was prescribing,” Matkovic
said.

Still, osteoporosis is both common and devastating, and doctors must stress prevention. Although
some bone loss is a normal part of the aging process, disease is not.

Getting enough calcium and vitamin D — either through foods or in supplements — can help keep
bones strong.